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Effectiveness of a bundled intervention including adjunctive corticosteroids on outcomes of hospitalized patients with community-acquired pneumonia: A stepped-wedge randomized clinical trial

JAMA Aug 11, 2019

Lloyd M, Karahalios A, Janus E, et al. - In a representative population hospitalized for community-acquired pneumonia, researchers assessed the efficacy of a bundle of evidence-supported treatments under conditions of routine care. Study participants included 816 patients hospitalized with community-acquired pneumonia. Among the intervention and control groups, an unadjusted geometric mean ratio of 0.95 was noted for the variation in the length of stay. However, no notable variations were observed for the secondary outcomes of mortality and readmission, and the outcomes persisted unchanged even following further adjustment for sex and age. Greater proportions of gastrointestinal bleeding in the intervention group vs controls was noted. This bundled intervention, including adjunctive corticosteroids, showed no proof of efficacy and resulted in an increased incidence of gastrointestinal bleeding. When implemented in combination, the effectiveness of individual interventions displayed in clinical trials may not necessarily translate into the effectiveness—and may even lead to net harm.

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